10 global health issues to watch in 2015

An empty Ebola virus decontamination zone at the Hastings treatment clinic as Ebola infection's decrease in Freetown, Sierra Leone, Friday, Jan. 23, 2015. With the Ebola outbreak weakening in West Africa, Sierra Leone eased restrictions on movement and commercial activity Friday even as the president warned that the fight against the deadly disease is not yet over. AP

No one could have predicted that Ebola would dominate global health headlines in 2014. We sure didn’t. The virus was nowhere to be found on IntraHealth’s Top 10 Global Health Issues to Watch in 2014 published last January. At the time, the global health community was focused on longstanding challenges such as HIV, family planning, maternal health—all of which have been derailed in some way by Ebola this year.

Will 2015 be some kind of a tipping point? Could it be the year the global health community finally begins to focus on the underlying health systems challenges brought to light by the Ebola epidemic? On the final push to end AIDS? On solving the critical shortage of health workers around the world?

All 7 billion of us will be affected in some way by at least one of these issues. They’ll shape what IntraHealth and other global development organizations do in 2015, and how we do it. Here are our top ten predictions:

Mental health. Child mortality, AIDS, maternal mortality—these and a handful of other issues have dominated the global health spotlight for years. But what about depression, post-traumatic stress disorder, dementia, substance abuse, and other mental health challenges that affect high- and low-income countries alike?

“Mental health and well-being are fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living, and enjoy life,” World Health Organization officials say.

Ethiopia is just one country that began focusing on mental health services in 2014, when it trained health workers to provide mental health care within prisons for the first time. As the civil unrest, economic instability, and traumatizing Ebola outbreaks of 2014 continue into 2015, mental health needs will only become more urgent—and so will the need for more trained social service workers, psychiatrists, and other health workers.

Cancer. Results from the largest cancer study ever published—released last month by the Lancet—show that cancer kills more people in low- and middle-income countries than HIV, malaria, and tuberculosis combined.

“The reason that some countries lag behind is not surprising; it’s a matter of how much is invested in cancer care,” NPR reported on the study. “Dr. Corey Casper, head of global oncology at the Fred Hutchinson Cancer Research Center in Seattle, met a doctor in Uganda a few years ago who was then seeing 10,000 patients a year ‘in a facility that had…no roof, inconsistent electricity, and no meds.’ What’s more, says Casper, he was the only cancer doctor in Uganda and four surrounding countries.”

Cancer and other noncommunicable diseases will not get all the attention and resources they deserve in 2015, because Ebola will likely stunt global progress in addressing them this year. But they will continue to be a growing challenge for us all, including frontline health workers around the world.

“If the world does not rapidly scale up in the next five years, the epidemic is likely to spring back with a higher rate of new HIV infections than today,” officials from the U.N. agency said.

That’s partly because half of the 35 million people who live with HIV today don’t even know they’re HIV-positive, so they don’t know they’re in danger of passing the virus on to others. This year will mark the first full year of a global strategy designed to avert 21 million deaths over the next 15 years. Can it help us address AIDS as a chronic illness, and make HIV’s threat to public health a thing of the past?

Family planning. “In a single year, from 2012 to 2013, we saw the number of women and girls using modern methods of contraception rise by 8.4 million,” says Dr. Roy Jacobstein, senior medical advisor at IntraHealth. “This is excellent progress, and very encouraging. But we can do more.”

FP2020, a global partnership to make family planning more widely available, will enter its third year in 2015, and it’s already reported some amazing global results—77 million unintended pregnancies averted, for example, and 125,000 women’s and girls’ lives saved. It also highlights Senegal’s impressive progress, including a new method of contraceptive distribution called the Informed Push Model, which completely eliminated contraceptive stockouts in all public health facilities in Pikine, Senegal, in just six months. Now the government is expanding the model nationwide.

This type of progress is possible everywhere, and we hope to see more of it in 2015.

Mobile tech. In the hands of trained, connected health workers, mobile technology has the power to transform health care. It can help a lone health worker in even the most remote, isolated village get up-to-date training and provide high-quality care. It can help patients avoid quacks. And it can help connect health workers to one another and to information that can save lives (including their own). In 2014, for instance, Liberia began using a technology called mHero that allows the Ministry of Health to send critical information to health workers’ mobile phones. And health workers can use it to send time-sensitive information to ministry officials and to one another. In 2015, this technology will help other countries combating Ebola and prepare them for future health threats as well.

War and unrest. More than half of all hospitals in Syria have now been attacked by Syrian forces, and over a third are no longer functional. Physicians for Human Rights says 578 health workers have been killed in the ongoing conflict. The violence of 2014—including in Syria, Ukraine, Gaza, South Sudan, Central African Republic, and Nigeria—is not over. War, civil unrest, and acts of terrorism can hinder or even reverse progress in all aspects of global development, including health, education, and gender equality.

Ebola. Ebola killed over 8,000 people in 2014, including hundreds of health workers. In 2015, West Africa and the world will continue struggling to contain the epidemic. We will also encounter Ebola’s devastating ripple effects: setbacks in HIV and maternal health progress, traumatized communities, and thousands of children orphaned by the disease and abandoned by their remaining family members. This last issue will add to the already great need for social service workers in West Africa who are trained and prepared to meet the specific needs of vulnerable children.

Ebola has made clear the global need to invest in health systems for the long term—and in health workers.

New sustainable development goals. This year marks target date for reaching the Millennium Development Goals, which have led to massive worldwide improvements in health and well-being over just 25 years. Now global leaders are finalizing a new set of objectives for global development: the sustainable development goals. These new goals could unite countries on the path toward one of the international community’s most ambitious goals: universal health coverage. To achieve it, we’ll need a greater focus on the global health workforce than the world has ever seen.

People-centered health systems.Perhaps more than any crisis in living memory, Ebola has shone a spotlight on the importance of people in health systems. Take away the people—as Ebola has done by killing 500 health workers in West Africa and beyond—and the system crumbles. Each part of the health system requires people to make health care work, and not just clinicians, but statisticians, finance experts, technologists, and, of course, all of us who seek health care services.

This year, individual countries and the global development community should begin (or continue) to ask a key question: How do we make our most valuable resources—human beings—a priority as we strengthen our health systems?

About Author

Margarite Nathe is senior editor/writer for IntraHealth International, a non-profit organization based in Chapel Hill, N.C. that believes everyone everywhere should have the health care they need to thrive. Nathe writes for the organization's blog VITAL and elsewhere about health, international development and the people who make it happen. The views expressed here represent those of the author.

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